ED Coding and Reimbursement Alert
Code Critical Care and Additional Services
Question: The ED physician spends a total of 108 minutes caring exclusively for a critically injured patient who has suffered a stroke of the carotid artery and an acute anterolateral wall acute myocardial infarction (AMI). The physician orders rapid sequence intubation to facilitate breathing, and uses a sequence of drugs during the intubation: 5 mg of intravenous Versed and 150 mg of IV succinylcholine. The intubation took seven minutes, and the physician spends the other 101 minutes of the encounter time at the patient's bedside or conversing with his wife to get medical information the patient cannot provide. Can I code the intubation and critical care separately? New Hampshire Subscriber Answer: 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the first 74 minutes of critical care +99292 (... each additional 30 minutes [List separately in addition to code for primary procedure]) for the remaining 27 minutes of critical care ) Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99291 and possibly +99292 depending on the payer to show that the critical care and intubation were separate services 31500 (Intubation, endotracheal, emergency procedure) for the intubation 433.11 (Occlusion and stenosis of precerebral arteries; carotid artery; with cerebral infarction) appended to 99291, +99292, and 31500 to represent the patient's stroke. 410.11 (Acute myocardial infarction; of anterolateral wall; initial episode of care) appended to 99291, +99292, and 31500 to represent the patient's heart attack.
You can code for the critical care and intubation; the drug supply codes are a no-go, though. On the claim, report the following:
ED Coding and Reimbursement Alert
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